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Proposition 61 was the most expensive ballot measure this year in California — indeed, one of the most expensive in state history. The "no" campaign, largely funded by Big Pharma, spent more than $109 million to defeat the measure, while supporters, led by the AIDS Healthcare Foundation of Los Angeles, spent about $18.5 million for its passage.

CNBC reported that if dollars were votes, "Big Pharma would be beating California's controversial drug-price control ballot measure Proposition 61 by a margin of about 7-to-1."

Proposition 61 would have prohibited state agencies in California from paying more for their employees’ medications than the VA does for veterans'. The measure would have lowered drug prices for about 12 percent of Californians, including employees of state agencies, low-income patients enrolled in Medi-Cal’s Fee for Service program and inmates of state prisons.

Although badly outspent in advertising, the Yes on Proposition 61 campaign had raised its visibility in recent days.

On Nov. 6, it began airing a series of 15-second ads showing the CEOs of such drug-industry titans — and prominent "no" funders — as Johnson & Johnson, Pfizer and Merck. The ads show the CEOs in "wanted" posters and report on the multimillion-dollar criminal and civil cases the drug companies in question have had to settle with the U.S. Department of Justice in recent years for conduct harmful to consumers of their products.

On Nov. 7, Sen. Bernie Sanders held rallies in Los Angeles and Sacramento to urge a vote in favor of Proposition 61. Sanders closed his remarks in Pershing Square to a crowd of some 200 cheering supporters by saying of Proposition 61 that "this could be the shot heard ’round the world."

Sanders' comment refers to the domino effect in pricing that the measure's proponents had been touting. They said that by pegging California state agencies to the VA’s price scale for drugs, it would serve as an example to all state Medicaid programs in the country and indirectly lower the prices paid by private insurers.

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Opponents said the drug-making monopolies would have shifted their losses onto the backs of the 88 percent of consumers who were not covered by the measure. The greed of drug makers was nowhere in dispute, but the question was whether this measure would account for it adequately. The voters of California have rejected the plan, by a count of 53.7 to 46.3 percent.

As recently as two months ago, the "yes" campaign was ahead by a 2-to-1 margin. A USC Dornsife/L.A. Times poll conducted from Sept. 1 to Sept. 8 found that a full two-thirds of California voters supported Proposition 61. But the major drug corporations like Johnson & Johnson, Merck and Pfizer turned up the heat in mid-October with $22.3 million in additional contributions to defeat the measure.

Those No on 61 dollars went to fund a blitz of advertising on TV and social media in recent weeks. The California Medical Association, representing the interests of more than 43,000 doctors in the state, opposed the measure, as did almost every veterans organization, arguing the measure would have prompted drug companies to boost prices on veterans, even though federal law protects veterans from price hikes on medicine.

Another health care–related measure on the ballot this year, Proposition 56, which adds a $2 tax to cigarettes and other tobacco products, was approved by voters. The measure, aimed at funding Medi-Cal for low-income state residents, won by a count of 63 percent to 37 percent.